Provider Demographics
NPI:1326051798
Name:BAYSTATE MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:BAYSTATE MEDICAL CENTER INC.
Other - Org Name:BAYSTATE HOME INFUSION AND RESPIRATORY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP, CFO & TREAS, BAYSTATE HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-794-3290
Mailing Address - Street 1:211 CARANDO DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3213
Mailing Address - Country:US
Mailing Address - Phone:413-794-4663
Mailing Address - Fax:413-794-5599
Practice Address - Street 1:489 BERNARDSTON RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1234
Practice Address - Country:US
Practice Address - Phone:413-773-2378
Practice Address - Fax:413-773-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110020829QMedicaid
MA110020829QMedicaid